CASE STUDY KIDNEY CANCER

In the United States, 2 percent of all cancers arise from the kidney. Each year, kidney cancer is diagnosed in approximately 52,000 Americans and is the cause of death in nearly 12,000 Americans. Kidney cancer is slightly more common in males and is usually diagnosed between the ages of 50 and 70 years. In adults, the most common type of kidney cancer is renal cell carcinoma. Other less common types of kidney cancer can occur. These include granular cell, mixed clear and granular cell, and sarcomatoid or spindle cell type. The incidence of kidney cancer seems to be increasing, though it isnt clear why. Many kidney cancers are detected during imaging for other conditions. Factors that increase the risk of kidney cancer include: smoking obesity hypertension family history of kidney cancer chronic kidney failure and/or dialysis diet with high caloric intake or fried/sauted meat von Hippel-Lindau disease Kidney cancer rarely causes signs or symptoms in its early stages. In later stages kidney cancer signs and symptoms may include: Blood in the urine, which may appear pink, red or cola colored. Back pain just below the ribs that doesnt go away. Abdominal mass or lump Rapid, unexplained weight loss. Persistent fatigue. Intermittent fever. Swelling in the feet and legs How is kidney cancer diagnosed? Unfortunately there are no blood or urine tests that directly detect the presence of kidney tumors. When a kidney tumor is suspected, a kidney imaging study is obtained. The initial study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. To plan the best treatment for the disease the doctor needs to know the stage (extent) of disease. The stage assigned is dependant on the size of the tumor, the extent of tumor spread and whether it has metastasized (spread) to other parts of the body. Stage I is an early stage of kidney cancer. The tumor measures up to or less than 7 cm and is confined to the kidney.

Stage II is also an early stage of kidney cancer, with the tumor still confined to the kidney, and measuring greater than 7 cm, but less than 10 cm. Stage III kidney cancer is defined by tumor extension beyond the kidney into surrounding tissue or major veins and one nearby lymph node. Stage IV kidney cancer is defined by spread outside the kidney, in multiple nearby lymph nodes, contiguous extension into the ipsilateral adrenal gland and to distant parts of the body such as the lungs, liver, bones or brain. Surgery is the initial treatment for the majority of kidney cancers. Surgical procedures used to treat kidney cancer include: Partial nephrectomy kidney sparing surgery that preserves some level of kidney function. The tumor is removed along with a small margin of healthy tissue that surrounds it. Radical nephrectomy Advanced kidney cancer cases may require the complete removal of the diseased kidney along with the adjacent lymph nodes and the adrenal gland. Ablation Kidney tumors can also be removed (ablated) with intense heat or cold. Cryoablation Cryoprobes freeze the tumor with intense cold. Radiofrequency ablation - Electrodes deliver radiofrequency energy to the tumor, and the intense heat destroys the tumor. Chemotherapy has shown limited effectiveness against kidney cancer. There are some new drugs and new combinations that may prove more helpful. Oraqfenib tosylate and sunitinib are new drugs that work by interfering with reproduction of cancer cells as they attempt to grow and divide uncontrollably. These drugs also have the advantage of being administered orally. Radiation therapy is not used to cure kidney cancer, but rather for alleviation of symptomatic metastasis. For example, the pain from bone metastases can be relieved by radiation to bone lesions. Biological or immunotherapy is treatment using compounds produced by the bodys immune system or laboratory-produced copies of them to treat the disease. Interferon and interleukin-2 are two examples of biological response modifiers being used for treatment of advanced kidney cancer. After treatment for kidney cancer, routine life-long surveillance is necessary. Surveillance typically consists of periodic assessment by a physician, blood tests and X-rays.
*Sources of this information include: http://www.medicinenet.com/kidney_cancer http://www.mayoclinic.org/kidney-cancer/treatment http://www.urologyhealth.org/adult/index.cfm?cat=04&topic=124&x=8&y=13

Kidney Cancer Incidence at Bon Secours MRMC 2005 2009

American Cancer Society statistics show there is a nationwide increase in the incidence of kidney cancer. The statistics from the Bon Secours Memorial Regional Medical Center cancer registry also indicate a rise in kidney cancer seen at Bon Secours MRMC. Starting in 2007, kidney cancer has been included in the top five sites at Bon Secours MRMC. The median age at diagnosis during the study time period is 62, with males having a higher incidence of kidney cancer than females. The majority of kidney cancer diagnosed has been in the early stage of disease. Patients at Bon Secours MRMC were treated appropriately with surgery. Compared to NCDB survival data, Bon Secours MRMC appears to be fairly close in the survival rate of patients with stages I and II disease. However, the NCDB data indicates that national survival rates for patients diagnosed with stage III disease are better than the survival rates being seen at Bon Secours MRMC for this population. The reason for this is unknown, but we do know that the majority of the patients seen at Bon Secours MRMC with stage III disease at diagnosis were at an advanced age. The majority of the stage III patients were in their mid to late 80s and had comorbid conditions that include diabetes mellitus, hypertension and congestive heart failure. At stage IV, the NCDB data shows a steady decrease in the rate of survival, as does the survival rate at Bon Secours MRMC, with a sharp drop after 4 years seen at Bon Secours MRMC.

Bon Se cours M RM C Kidne y Cance r Cas e s pe r Ye ar 2005-2009 Y r. 2009 Y r. 2008 Y r. 2007 Y r. 2006 Y r. 2005 0 10 20 30 40 50

Bon Se cours MRM C Kidne y Cancer 2005-2009 AJCC Stage at Diagnos is Unk Stage Stage IV Stage III Stage II Stage I Stage 0 0.00% 20.00% 40.00% 60.00% 80.00%

Bo n Se co ur s M RM C Kid n e y Cance r 20052009 Ag e b y Se x 40% 35% 30% 25% 20% 15% 10% 5% 0% <30 30- 40- 50- 60- 70- 8039 49 59 69 79 89

Male Female

Bon Se cours M RM C Kidne y Cance r 20052009 Firs t Cours e Tre atm e nt 100% 80% 60% 40% 20% 0%
g/ Ch em o Su rg /Im m un o Ch em o Su rg No Tx

Su r

Bon Secours MRMC Kidney Cancer Five Year Survival Rate by Stage 120% 100% 80% 60% 40% 20% 0% Stage at dx 1 yr 2 yr 3 yr 4 yr 5 yr Stage I Stage II Stage III Stage IV

NCDB Kidney Cancer Five Year Survival Rate by Stage

120% 100% 80% 60% 40% 20% 0% Stage at dx 1 yr 2 yr 3 yr 4 yr 5 yr Stage I Stage II Stage III Stage IV